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Escrow No. F0376352 REAL PROPERTY TRANSFER DECLARATION (TD -1000) GENERAL INFORMATION Purpose: The Real Property Transfer Declaration provides essential information to the county assessor to help ensure fair and uniform assessments for all property for property tax purposes. Refer to 39 -14- 102(4), Colorado Revised Statutes (C.R.S.). Requirements: All conveyance documents (deeds) subject to the documentary fee submitted to the county clerk and recorder for recordation must be accompanied by a Real Property Transfer Declaration. This declaration must be completed and signed by the grantor (seller) or grantee (buyer). Refer to 39- 14- 102(1)(a), C.R.S. Penalty for Noncompliance: Whenever a Real Property Transfer Declaration does not accompany the deed, the clerk and recorder notifies the county assessor who will send a notice to the buyer requesting that the declaration be returned within thirty days after the notice is mailed. If the Completed Real Property Transfer Declaration is not returned to the county assessor within the 30 days of notice, the assessor may impose a penalty of $25.00 or .025% (.00025) of the sale price, whichever is greater. This penalty may be imposed for any subsequent year that the buyer fails to submit the declaration until the property is sold. Refer to 39- 14- 102(1)(b), C.R.S. Confidentiality: The assessor is required to make the Real Property Transfer Declaration available for inspection to the buyer. However, it is only available to the seller if the seller filed the declaration. Information derived from the Real Property Transfer Declaration is available to any taxpayer or any agent of such taxpayer subject to confidentiality requirements as provided by law. Refer to 39- 5- 121.5, C.R.S and 39- 13- 102(5)(c), C.R.S. I. Address and/or legal description of real property: Please do not use P.O. Box numbers. vacant land Penrose, CO 81240 fv ot,/ 2. Type of property purchased: ❑ Single Family Residential ❑ Townhome ❑ Condominium ❑ Multi-Unit Res ❑ Commercial ❑ Industrial ❑ Agricultural ❑ Mixed Use Q Vacant Land ❑ Other 3. Date of Closing: September 29, 2011 Month Day Year Date of Contract if different from date of closing: September 29, 2011 Month Day Year 4. Total sale price: Including all real and ersonal property. $14,200,000.00 __-. 5; f/, /35;5".? Tref.,ft ex" 5. Was any personal property included in the transaction? Personal property would include, but is not limited to, carpeting, draperies, free s ding appliances, equipment, inventory, furniture. If the personal property is not listed, the entire purchase price will be umed to be for the real property as per 39 -13 -102, C.R.S. ❑ Yes No If yes, approximate value $ Describe 6. Did the total sale price include a trade or exchange of additional real or personal property? If yes, give the approximate value of the goods or services as of the date of closing. ❑ Yes Q No If yes, value $ If yes, does this transaction involve a trade under IRS Code Section 1031? ❑ Yes ❑ No 7. Was 100% interest in the real property purchased? Mark "no" if only a partial interest is bemg purchased. ❑ Yes ❑ No If no, interest purchased 8. Is this a transaction among related parties? Indicate whether the buyer or seller are related. Related parties include persons within the same family, business affiliates, or affiliated corporations. ❑ Yes Q No If the property is financed, please complete the following. 10. Total amount financed: $ 0 9. Check any of the following that apply to the condition of the improvements at the time of purchas ❑ New ❑ Excellent ❑ Good ❑ Average ❑ Fair ❑ Poor ❑ Salvage. N/A 4 3/0, F is 11. Type of financing: (Check all that apply) ❑ New ❑ Assumed ❑ Seller ❑ Third Party ❑ Combination; Explain 12. Terms: ❑ Variable; Starting interest rate ❑ Fixed; Interest rate ❑ Length of time years Balloon payment ❑ Yes ❑ No If yes, amount $ Due date 13. Mark any that apply: D Seller assisted down payments, 0 Seller concessions, 0 Special terms or Financing. If marked, please specify: For properties other than residential (Residential is defined as: single family detached, townhomes, apartments and condominiums) please complete questions 14 -16 if applicable. Otherwise, skip to #17 to complete. RPTRNSFR File No. F0376352 Real Property Transfer Declaration